The grading of lymphedema in oncology clinical trials

Andrea L Cheville, Charles L. McGarvey, Jeanne A. Petrek, Sandra A. Russo, S. R J Thiadens, Marie E. Taylor

Research output: Contribution to journalArticle

99 Citations (Scopus)

Abstract

Lymphedema is a common late toxicity of cancer therapy. This article describes the rationale and process utilized by the Lymphedema Working Group for the revision and expansion of the Common Toxicity Criteria version 2 (CTC v2.0) lymphedema criteria to produce the CTC v3.0 lymphedema criteria. Established clinician-based rating scales and quantitative instruments are reviewed in this article. None of the extant rating scales have been formally validated, nor has their reliability been assessed. Drawbacks of current scales were considered in formulating CTC v3.0 criteria. Most rely exclusively on volume to diagnose and grade lymphedema. This imposes significant clinical limitations, particularly in the assessment of toxicity in oncology clinical trials. Volume-based rating scales are of little value in rating the severity of bilateral limb and nonlimb edema. Problems with nonvolumetric staging systems (eg, CTC v2.0) include insufficient detail to permit useful discrimination of severity among the majority of lymphedema patients. Technologies for objectively quantifying lymphedema have been developed and validated. Although these are briefly reviewed, it is recognized that cost and access issues limit their wide-spread clinical utility and, as such, were not considered in developing the CTC v3.0 criteria. The CTC v3.0 lymphedema criteria adopted several innovations. Principle among these was the decision to generate separate criteria for volumetric increase, dermal changes, and subcutaneous fibrosis. We anticipate the use of the new CTC v3.0 lymphedema criteria to begin in mid-2003 for grading the key clinical features of this disorder in oncology clinical trials. The purpose of this article is to familiarize the reader with (1) background on the clinical features of lymphedema, (2) information on established lymphedema rating systems, (3) the consensus process and rationale of the Lymphedema Working Group, (4) the new CTC v3.0, and (5) quantitative techniques for assessment of lymphedema.

Original languageEnglish (US)
Pages (from-to)214-225
Number of pages12
JournalSeminars in Radiation Oncology
Volume13
Issue number3
DOIs
StatePublished - Jul 2003
Externally publishedYes

Fingerprint

Lymphedema
Clinical Trials
ratings
toxicity
edema
fibrosis
readers
limbs
discrimination
grade
therapy
cancer
disorders
costs
expansion
Edema
Fibrosis
Extremities

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Radiological and Ultrasound Technology

Cite this

Cheville, A. L., McGarvey, C. L., Petrek, J. A., Russo, S. A., Thiadens, S. R. J., & Taylor, M. E. (2003). The grading of lymphedema in oncology clinical trials. Seminars in Radiation Oncology, 13(3), 214-225. https://doi.org/10.1016/S1053-4296(03)00038-9

The grading of lymphedema in oncology clinical trials. / Cheville, Andrea L; McGarvey, Charles L.; Petrek, Jeanne A.; Russo, Sandra A.; Thiadens, S. R J; Taylor, Marie E.

In: Seminars in Radiation Oncology, Vol. 13, No. 3, 07.2003, p. 214-225.

Research output: Contribution to journalArticle

Cheville, AL, McGarvey, CL, Petrek, JA, Russo, SA, Thiadens, SRJ & Taylor, ME 2003, 'The grading of lymphedema in oncology clinical trials', Seminars in Radiation Oncology, vol. 13, no. 3, pp. 214-225. https://doi.org/10.1016/S1053-4296(03)00038-9
Cheville, Andrea L ; McGarvey, Charles L. ; Petrek, Jeanne A. ; Russo, Sandra A. ; Thiadens, S. R J ; Taylor, Marie E. / The grading of lymphedema in oncology clinical trials. In: Seminars in Radiation Oncology. 2003 ; Vol. 13, No. 3. pp. 214-225.
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